October 30, 2013

Should This Inmate Get a State-Financed Sex Change Operation?

What we owe a murderer

The warden wouldn’t allow Michelle Kosilek to buy cosmetics, so she made them in her cell. For liquid foundation, she blended pulverized chalk—pink, yellow, and white—with Eucerin lotion. For lipstick, she melted Chapstick in the metal top of a gallon jug, then added red ink, and, as an emulsifier, Vaseline. For nail polish, she combined liquid floor wax with ink from a Sharpie and painted on the mixture with the built-in brush applicator from a Wite-Out bottle. Her eyeliner was a black grease pencil.

After a decade of this, the prison finally let Kosilek purchase her cosmetics from the women’s canteen. Kosilek feels she’s not herself without them. But during the afternoon, should she happen to lean her cheek against her hand, she’ll sometimes feel a disgusting sensation. Horrified, she’ll stop whatever she’s doing and hurry back to her cell, where she’ll stand at her sink and scrape a razor across her cheek again and again until she can find no trace of stubble.

To suffer from gender dysphoria (G.D.), as Michelle Kosilek does, is to exist in a real state for which our only frame of reference may be science fiction. You inhabit a body that other people may regard as perfectly normal, even attractive. But it is not yours. That fact has always been utterly and unmistakably clear to you, just as the fact that she has put on someone else’s coat by accident is clear to a third-grader. This body has hair where it shouldn’t, or doesn’t where it should. Its hands and feet are not the right sizes, its hips and buttocks and neck are not the right shapes. Its odors are nauseating. To describe the anguish a G.D. patient suffers, psychiatrists will allude to Gregor Samsa in Kafka’s The Metamorphosis: For Michelle Kosilek, the gulf between human being and insect is precisely as wide as that between woman and man.

Associated Press/New Rochelle Police Department

Robert Kosilek

Kosilek is now 64 years old, and she has spent the last 20 years of her life at MCI Norfolk, a medium-security men’s correctional institution in southern Massachusetts. She has attempted suicide twice. She has also tried to castrate herself by tying off her testicles, a grisly method farmers use on hogs.

In 2002, a judge ordered the prison to provide Kosilek with a psychiatric evaluation to determine how to treat her gender dysphoria. By 2006, no fewer than five specialists had recommended that she undergo sexual-reassignment surgery (SRS).

Prisoners, unlike the rest of us, are constitutionally entitled to free health care. They are wards of the state: The Supreme Court affirmed their right to “adequate medical care” in the 1976 case Estelle v. Gamble. To deny them this would violate the Eighth Amendment’s proscription against “cruel and unusual punishment.” But transgender inmates have found it extraordinarily difficult to prove in court that gender dysphoria treatment meets the Estelle standard. Many judges view them unsympathetically: This is an unusual mental illness whose legitimacy many in the public still doubt; these are plaintiffs serving long sentences for committing horrifying crimes.

When the Massachusetts Department of Corrections (MDOC) refused to provide SRS to her, Michelle Kosilek sued for the right to change her gender and instantly became a living symbol of a soft- on-crime entitlement society. She “made a mockery of our entire penal system,” as Boston Globe columnist (now editor) Brian McGrory put it. A Globe reader from West Hartford, Connecticut, wrote, “I’ll commit a crime serious enough to get me thrown in prison [and] make the state pay for plastic surgery, because I’ve always believed that my true self looks a lot more like George Clooney, or maybe Tom Cruise.”

As Kosilek v. Spencer began in U.S. District Court in Boston, Kosilek’s pro bono attorney declared that sexual-reassignment surgery was the only adequate medical treatment in this case. The law, the attorney said, obligated the state to provide SRS to her client—even if Kosilek, who so desperately wanted to be a woman, was serving a life sentence for murdering one.

Early in the morning of May 23, 1990, police executed a search warrant at a new three-story duplex on Concetta Circle in Mansfield, Massachusetts, a small commuter town about 30 miles south of Boston. The house belonged to Robert and Cheryl Kosilek, both of whom worked as substance-abuse counselors at nearby hospitals, and Cheryl’s teenage son Timothy. On the previous night, police had discovered Cheryl’s body in the parking lot of the Emerald Square Mall, a 20-minute drive away. She lay beneath a blanket in the back seat of her gray Hyundai. Her top had been pulled up, her pants pulled down. She had been garroted with both wire and rope and nearly decapitated.

A short, dark-haired, heavy-set man of 41 emerged from the Kosilek home and spoke to the newspaper and TV reporters gathered outside. “My best friend has been killed, and they tell me they think I did it,” Robert Kosilek declared, fighting back sobs. “Of course I didn’t ... I couldn’t do that to anyone.”

Boston Herald

Michelle Kosilek

At the age of four, Kosilek announced to his mother, a waitress at greasy spoons, that he was really a little girl. (Kosilek’s father was serving a long sentence in federal prison for mail fraud.) Not long afterward, she abandoned him at an orphanage, only to come back for him six years later, while on an alcoholic bender with another boyfriend. Home was no more welcoming than before: He was frequently punished for dressing as a girl, and his mother’s father began raping him. Gradually, he realized he could earn more with his body than the dollar his grandfather gave him every week, and at the age of twelve, he became a child prostitute on the streets of Chicago. But he wasn’t attracted to men, which alienated and confused him all the more. When he showed his mother that his breasts, as a result of a hormonal condition during puberty, had begun growing, her boyfriend beat him with a fiberglass fishing pole, then made him kneel on a layer of uncooked rice. One day, at the newsstand just outside the public bathroom where Kosilek picked up johns, he found a magazine article about Christine Jorgensen, a glamorous, pioneering transgender woman who underwent SRS in 1952. It was a revelation: “I was not the first person in the world like this.”

In his mid-twenties, Robert became addicted to heroin. When he wasn’t turning tricks to support his habit, he shoplifted or burgled people’s homes. When he could get hold of female hormones, he took them.

He moved from coast to coast working variously as a dishwasher, a truck driver, a garbage collector, a construction worker, a furniture restorer, a warehouse manager, a private in the U.S. Army (before being “undesirably discharged” for going awol and cross-dressing), a packer at a condiment factory, and a bus driver for preschool children. While he was locked up on robbery and marijuana possession charges in the late ’60s and early ’70s, he was twice gang-raped by other inmates, he claims.

On different occasions he was stabbed with an ice pick, a paring knife, and a camping knife; slashed with a scimitar; and beaten over the head with a pool cue. By 1983, he had become an alcoholic. In the fall of that year, he lost a job in Chicago for showing up drunk; four days later, he woke up in Cambridge Common, across the street from Harvard, with no idea of how he’d gotten there. One morning, he threw up blood while slugging vodka from a bottle. He eventually checked into rehab, then into a halfway house in New Bedford. “Have you ever heard of Christine Jorgensen?” he asked the admissions counselor. “I’m like her, and that’s why I’ve been a drunk for most of my life.”

The counselor referred him to a colleague with expertise in “sexual issues” and Kosilek began treatment with her. “The cure for your condition,” his new counselor told him, “is the love of a good woman.” At the end of one of their first sessions, she said, “You look like you need a hug.” The hug turned into a kiss. Four months later, the counselor invited him to move in with her, and within the year, she and Kosilek were married. Her name was Cheryl.

She was a divorced mother of two boys, a onetime aspiring model who was said to resemble Lynda Carter, the actress who played Wonder Woman on television. After her first marriage came apart, she’d had a rough time; for a while, she and her sons had lived on public assistance. But she’d gotten a master’s in education and had begun helping troubled young women—rape victims and substance abusers. According to Kosilek, she might have been drawn to this work because she herself had been raped years earlier.

In interviews with police, Kosilek’s alibi—he claimed he’d been working around the house all day—quickly fell apart. The search warrant at Concetta Circle turned up blood and other evidence indicating Cheryl had been killed there. A taxi driver recalled picking up Kosilek at the Emerald Square Mall, where Cheryl’s body had been discovered, on the day of the murder. On the afternoon of May 24, while attempting to flee, Kosilek was stopped for speeding in New Rochelle, New York, 200 miles from his home. The arresting officer smelled alcohol on Kosilek’s breath and found a bottle of vodka and two beer cans on the floor of the car. “I can’t call my wife,” Kosilek told him. “I murdered my wife.”

There are competing accounts of what happened. Did Cheryl and Robert argue because he had relapsed after eight years of sobriety? Because she had discovered him wearing her clothes? According to Kosilek, they fought because he told her she wasn’t strict enough with her older son. She snapped at Kosilek; he said she was “PMS-ing” and “crazy.” At that, she flung a mug of hot water at him, soaking his bathrobe and scalding his genitals. He lost control, striking her and knocking her down. When she seized a kitchen knife and came at him, he grabbed a length of baling wire and knocked the knife loose. She dove for it, he dove for her. The next thing he remembers is waking up four days later in the psychiatric ward of the Westchester County Jail in New Rochelle. He claimed that post-traumatic stress disorder, the result of a lifetime of physical and emotional abuse, had made him black out. But he insisted that he had acted in self-defense: Cheryl was an inch taller and 45 pounds heavier, he said.

On January 14, 1993, Kosilek, pale and gaunt after 32 months in jail awaiting trial, arrived at the courthouse in New Bedford, Massachusetts. His long hair fell to his shoulders. He had on a turquoise and gray sweater, dangling gold earrings, fuchsia socks, and large fashion eyeglasses. The prosecutor said, “As long as it’s tasteful, I’m not going to make an issue out of this.”

“We didn’t know that he was doing this kind of stuff,” says Laura Brandel, Cheryl Kosilek’s niece. “When we saw him, we were disgusted. Just the fact that he was married to her and what he did to her and now he’s in women’s clothes. ... It was just a freak show.”

Associated Press

Robert Kosilek, in 1990, just four days after murdering his wife.

According to a 2011 study by the Williams Institute at UCLA, there are approximately 700,000 self-identified transgender people in the United States. Of those, some 28,000 suffer from male-to-female G.D. severe enough to reach clinical criteria, says George Brown M.D. of East Tennessee State University, who consulted for the plaintiff in Kosilek’s lawsuits. At any given time, says Brown, up to 1,000 people in the latter group—one out of every 28—are incarcerated.

The reasons for this are manifold: staggeringly high rates of homelessness and unemployment; of housing, job, and police discrimination; of addiction; and of involvement, for lack of other resources, in illegal work like prostitution and drug dealing. The difficulty transgender people experience in finding both employment and a sense of community may explain why 20 percent of them (including Kristin Beck, the ex-Navy seal who recently wrote a memoir, and Chelsea Manning) have served in the military.

In the hypermasculine atmosphere of a men’s prison, life can be hellish for the transgendered. In a 2007 California study, 59 percent of trans people who have been locked up said they had been sexually assaulted, versus only 4 percent of the general prison population. Sarah, an inmate at the Washington Corrections Center in Shelton, Washington, wrote a testimonial for the prison-rights organization Just Detention in which she described being gang-raped by two guards and a sergeant who chanted, “We’ll show you how to be a woman.” Afterward, she was denied a rape kit and the opportunity to make a formal complaint, then was segregated in mental-health detention for two weeks so that she couldn’t speak with a city detective who had been contacted on her behalf. After being returned to the general population, she was raped in a janitor’s closet in front of witnesses. Prison authorities never interviewed them and proceeded to house her directly next to the inmate who had raped her. “There is no one to talk to about this ...” she wrote.

Transgender inmates are also discriminated against when they seek medical care, especially care related to gender transition. According to the 2011 National Transgender Discrimination Survey, 12 percent of trans inmates reported denial of routine health care and 17 percent denial of female hormones.

Yet prisoners in general are discriminated against when they seek medical care. “For the most part, medical care in prisons and jails is profoundly inadequate, to the point of regularly endangering people’s lives and well-being,” says Sharon Dolovich of UCLA School of Law.

In Massachusetts, as in the rest of the country, rising costs, along with budget cuts, have created a many-layered health care bureaucracy that is four parts economic triage, one part medicine. In 2011, the Massachusetts Department of Corrections hired MGT of America, a public-sector management consultant, to evaluate the cost efficiency of its prison health care system. MGT’s report approvingly noted that the state’s monthly expenditures per capita were among the lowest in the country.

According to Joel Thompson of Prisoners’ Legal Services in Boston, inmates in Massachusetts typically wait three months to see a specialist or undergo a test. The MDOC subcontracts its specialist care to several different providers, and appointments are costly because they often lead to new diagnoses. Rather than determine its cause, contractors often treat the symptom in the simplest way—Motrin, antacid, skin lotion. A Massachusetts prisoner who was fighting deportation to the Dominican Republic died of sepsis, allegedly because prison officials delayed sending him to a specialist. Another inmate, suffering from a rare form of cancer, was denied an expensive targeted-chemotherapy drug and died shortly afterward. Up to one-third of the state’s general prison population suffers from Hepatitis C, yet the state balks at providing the newest and most effective drugs, which can cost as much as $80,000 annually per prisoner.

Prison authorities often assume inmates are gaming the health care system in hopes of going on van rides to the hospital, or transferring to better housing, or getting medications they like but don’t actually need. “I had a client once who was accused of ‘angling’ for an endoscopy,” says Thompson. “Who in their right mind tries to manipulate the system to obtain an unnecessary endoscopy?” Between 2007 and 2010, the MDOC recorded 18 suicides, more than double the national average for that time period. Today, nearly 40 percent of the 11,000 inmates in the system take anti-depressants, which are often prescribed as a cure-all in lieu of therapy or anti-psychotics.

It was against this backdrop that Michelle Kosilek, an inmate suffering from a rare and poorly understood mental illness, pressed her demand for an operation that would cost an estimated $20,000.

MCI-Norfolk is located 30 miles south of Boston amid 400 acres of wetlands and marshes. It’s a 20-minute drive from the house where Robert Kosilek strangled his wife, Cheryl. From the outside, during evening visiting hours, the prison is monolithic and silent. Its floodlit, sheer concrete walls are 19 feet high and stretch so far into the distance, a quarter of a mile on each side, that they seem fake, like an optical illusion. At each corner rise squat towers in which unseen guards, armed with high-powered rifles, keep watch.

The prison’s visitors’ center is an airy, vaulted room of exposed wood and glass. On the night last August when we met there, Michelle Kosilek was dressed in fraying jeans made of coarse denim and a slightly oversize white pocket T-shirt. She wore ancient but clean white-on-white Nikes. The grip of her large hands, when we greeted each other, was powerful.

The visitors’ center is furnished with uncomfortable modular plastic chairs that require you to sit side by side with the person you’re meeting. Presumably, this provides guards and cameras with unobstructed views of attempts to smuggle drugs, cell phones, and other contraband. I asked Kosilek if I could buy her something from the vending machines. “Do they have frozen ice cream bars?” she asked. “Is there something like a Nutty Buddy?” I checked: There was. “Yes, please!” she practically shouted, bouncing up and down in her chair. In a room that was filling up with haggard young men, her vitality was at odds with the general mood. The effect wasn’t campy, exactly, but it seemed strange and exaggerated, particularly in a middle-aged person.

Kosilek neatly unwrapped her ice-cream cone. She was wearing lipstick, blush, and eyeliner, along with a pair of small, rectangular plastic eyeglasses. Her black hair, graying only at the temples, fell thickly to her waist. “Normally I wear it up, because of the humidity, but I knew I was coming to an air-conditioned room,” she said. “At night, usually I braid it so it doesn’t end up in my mouth.” In photographs, she has the proud but deluded air of someone who doesn’t realize she’s not quite pulling this off, but in person her features are smaller and finer. She is persuasively a woman, even a pleasant-looking one. “Bless you!” she exclaimed when I told her so. She clasped my hand. Then she scrutinized me and said: “Is that what this visit was all about? You wanted to see?”

Courtesy of Michelle Kosilek

Kosilek gave this photo to a psychologist after changing her name.

As she told me about her life in prison, Michelle Kosilek made extravagant gestures with her hands and spoke in a high-pitched voice that she said was modeled on her mother’s. She’d taught herself to use it by reading Stephen King’s novel The Stand out loud in her cell.

MCI-Norfolk was designed in the 1920s by a Harvard professor with progressive ideas about rehabilitation, and it retains some of his humane innovations. It has a pretty quadrangle campus like a college’s. Inmates tend a vegetable garden and share the fresh produce they grow. They can cook for themselves using their own pots and pans and the prison’s microwaves and toaster ovens. They are allowed to have televisions and radios and musical instruments. If you break the rules, you can be reassigned to “the max joint,” so inmates generally behave. “I’m a lesbian,” Kosilek tells the male prisoners, and they generally respect this. (Some respond, “That’s funny—I am, too.”) She has never been attacked in this prison.

Shortly before 7 a.m. each morning, Kosilek’s cell is unlocked and she leaves immediately to go to work. She’s responsible for refilling cleaning supplies and distributing them to the janitors in her cell block. (She previously held a much higher-paying job as a seamstress in correctional industries but quit after being repeatedly, she believes punitively, strip-searched.) After work, she has special permission to shower alone. The walls of the shower are made of stainless steel and she averts her eyes to avoid seeing the reflection of her naked body.

Every day, she goes outdoors for a power-walk. (She had to quit jogging: Her breasts, which were growing because of hormone treatments, brought her unwelcome attention.) Other inmates often harass her anonymously from windows overlooking the prison yard: “Kill yourself, you fucking freak!” Afterward, she returns to her cell to work on the second volume of her memoirs. (She self-published the first, Grace’s Daughter, online.) She also corresponds with a male-to-female transgender inmate with whom she’s having a long-distance romantic relationship; they’ve never met in person.

Sometimes she goes to the library to research legal briefs for herself or her “sisters” at Norfolk, whom she helps to petition judges for everything from psychiatric evaluations to laser hair-removal and electrolysis. One such sister is Sandy Jo Battista, who kidnapped and raped a ten-year-old girl. With Kosilek’s support Battista won a lawsuit that entitled her to hormone treatments while incarcerated. Battista has since been released from prison, but was deemed too much of a threat to public safety to be returned to civil society. For the past decade, she has been committed, indefinitely, to the Massachusetts Treatment Center for Sexually Dangerous Persons. “Sex offenders should have the same rights I do,” Kosilek told me. “I did anything I could for her. I had to.”

In 2000, Kosilek sued the state for the second time, alleging that her Eighth Amendment rights had been violated because the MDOC wouldn’t provide her with specialized treatment for gender dysphoria. In that case, Judge Mark Wolf ruled against her. He found that the commissioner of corrections had acted without “deliberate indifference,” not being sufficiently informed about the needs of transgender people. But Judge Wolf also ruled that gender dysphoria is a serious medical condition requiring treatment. He ordered that Kosilek be provided with a psychiatric evaluation and that its recommendations be followed—whether for psychotherapy, hormone treatment, or even SRS. He also put the commissioner on notice: If the MDOC continued to deny adequate medical care to Kosilek, the lawsuit would be reopened.

In fact, the MDOC would go on to fire, replace, or simply ignore five specialists who concluded that Kosilek should undergo SRS. A new trial began in May of 2006. Kosilek testified in June of that year that she would prefer dying to inhabiting the body of a man for the rest of her life. “I would not want to continue existing like this,” she said. The psychiatrists who had examined her concluded that sexual-reassignment surgery would be “curative” for her G.D., as it is for the majority of the transgender people for whom it’s prescribed. If she were not offered SRS, they said, she would likely keep trying to kill herself until she succeeded.

On the stand, the commissioner of corrections, Kathleen Dennehy, admitted that she would rather retire than obey an order from the U.S. Supreme Court that would make her the first prisons commissioner in the United States to provide SRS to an inmate. Judge Wolf determined that Commissioner Dennehy’s real objection to ordering the surgery for Kosilek was fear of “public and political controversy, criticism, scorn, and ridicule.” On September 4, 2012, in a scathing opinion, the judge wrote that the MDOC had violated Kosilek’s Eighth Amendment rights by engaging in “a pattern of pretense, pretext and prevarication.” He ordered the state to provide Kosilek with SRS.

In an election year, the reaction was swift and strident. Republican Senator Scott Brown issued a statement condemning the judge’s order, as did his Democratic opponent Elizabeth Warren, who chose her words carefully: “I have to say, I don’t think it’s a good use of taxpayer dollars.” On Fox News, Bill O’Reilly called the case “insane.” Even Barney Frank—who, as The Advocate observed in an angry op-ed, might have seemed, as a gay man, to be Kosilek’s natural ally—denounced the decision. “I think some of the LGBT advocates say, ‘Oh, there have got to be special rules for people who are transgender,’” he told me. “Alleviating at public expense the anguish of a murderer is not something I want to do.”

Much of the reaction seemed to question whether gender dysphoria is really a severe mental illness. “I don’t see how it’s the state’s responsibility to treat this ‘condition’ for anyone while they’re incarcerated,” Timothy McCaul, Cheryl Kosilek’s oldest son, wrote to me in an e-mail. But none of the objections could take issue with the state’s legal analysis. “When a prisoner’s case actually gets to court and the person seems to be getting the protection of the Eighth Amendment, it can seem crazy,” says Sharon Dolovich. “But in my view, Judge Wolf’s ruling is absolutely right on the law.”

We enter into a kind of compact with the people we incarcerate. Much as we might like to put them out of mind—behind 20-foot-tall, quarter-mile-long, immaculate walls erected in the middle of nowhere—we are, by the act of imprisoning them, bound more closely to them than ever. They are entirely dependent on us for food, clothing, shelter. Is it right that we brandish that dependence over them like a threat? Is it ethical for us to treat some legitimate medical conditions but not others? What does society owe to the worst among us? “Eighth Amendment protections are not forfeited by one’s prior acts,” wrote future Supreme Court Justice Anthony Kennedy in 1979. Yet there is a point at which even progressive legal scholars hesitate to champion those protections. Dolovich teaches her law students about a bank robber in California who received a heart transplant in 2008 while serving a 14-year sentence. The cost of the operation, including follow-up care, was more than a million dollars. The fact that the bank robber got the heart meant that someone else, someone law-abiding, didn’t.

What people really seem to be arguing about in Kosilek is what incarceration means. One school of thought holds that the deprivation of liberty is itself the punishment, full stop. When we impose conditions that cause pain and suffering—when, for instance, we withhold surgery that would bring a prisoner’s body into harmony with her consciousness—we’re inflicting a punishment above and beyond the legally mandated one.

The opposing school holds that, when you commit a heinous crime, you are sentenced not only to serve time but also to endure, arbitrarily, the conditions of the prison where you happen to be confined: everything from a moldy cell to unjustified detention in solitary confinement to sexual assault to the caprices of health care in the correctional system. No matter the severity of your crime, you knowingly broke society’s laws, so you deserve whatever happens to you in prison, even if you’re suffering so much that you, like Kosilek, want to die.

“It doesn’t bother me if she wants to commit suicide,” says Barney Frank. “What’s the loss to society?” Last August, in the visitors’ center, I told Michelle Kosilek about Frank’s remark and she seemed stunned. “Does he not believe in the possibility of redemption?” she said finally.

As she finished her ice cream, she became self-conscious. “Is my lipstick gone?” she asked, licking her lips. She nervously swept back her hair with her index fingers. She didn’t tuck it behind her ears, and I wondered if she might be self-conscious about their size. Would SRS rid her of insecurity about her body? I asked. “Of course not,” she said. She held out her arms: “Look at these big fucking Polish peasant hands.” The hair on her face continued to cause her distress. Kosilek’s electrolysis treatments had been terminated without explanation in 2008, and she has been trying to resume them ever since. To eliminate her beard entirely would require eight more hours of sessions, she told me, at an estimated cost of $5,000. Once her surgery was done, she expected to be moved, at long last, to the state’s only women’s prison, in Framingham, about 20 minutes away. A transfer wasn’t guaranteed, but she was prepared to fight the MDOC again in court.

Kosilek smelled, I noticed now, of fresh laundry. It was the smell not of an adult woman but of a girl. Then it struck me: Her overdone mannerisms—the hand gestures, the theatrical enthusiasm, the way she swept her hair out of her face—were those of someone much younger. She hadn’t been living as a woman long enough to act her age.

The administration of Governor Deval Patrick has appealed the Kosilek verdict. Patrick argues that the MDOC was already providing constitutionally adequate medical care to Kosilek, and that security concerns prevent them from offering surgery to her, no matter the medical necessity. Judge Wolf scoffed at the state’s argument that Kosilek, at the age of 64, and on the verge of receiving the treatment she’d sought for two decades, might try to escape en route to her surgery. Kosilek’s counsel, Joseph Sulman, calls the appeal “meritless,” and many legal observers agree with him. (The MDOC, citing pending legislation, wouldn’t comment for this story, though, as Judge Wolf notes, they have “selectively” done interviews with media whom they “knew would be hostile” to Kosilek’s position.) The appeals court decision is expected imminently.

Christine Alexander, another transgender inmate at MCI-Norfolk, told me that some of her fellow prisoners resent Kosilek’s success in court. “They think, ‘How come this person’s getting all this stuff but we can’t get our teeth cleaned?’ ” Kosilek insists that her case has given them hope: “If I can have a vagina,” she says, “they can have their fuckin’ knee fixed.”

By now, an hour into our conversation, the visitors’ center had filled with prisoners and their families, at least a hundred people in all. Many of the inmates were leading black lab puppies on leashes—service dogs in training. Kosilek was watching a family seated at a table in an enclosed area opposite us. A little girl of about two and her father were playing with blocks together. Kosilek talked about the girl being raised by a single mother, not yet understanding why she’s able to see her father only here in this room, not yet grasping what this place is. “I’m thinking about all the things that can go wrong as she gets older,” she said.

Cheryl Kosilek was 36 when she died. “That’s a debt I can never repay,” Kosilek told me. A lawyer is now representing her in an appeal of her first-degree conviction; if she can get it reduced to a second-degree charge, she’ll be eligible for parole. She acknowledged her chances are “slim.” “I took my best friend’s life because I was afraid that she was going to take mine,” Kosilek said. “And I can’t”—she began softly crying—“make that go away.” I believed in her sincerity, and yet I didn’t. Just as she’s been conditioned to anticipate the whistle that blows four times a day to summon inmates for a head count, so it seemed to me that prison must have taught her to pour out her remorse on command.

Yet in ways both glaringly obvious and hidden, Michelle Kosilek is not the same person she was on the day she killed her wife. It’s an essential human project to seek not only to endure as the years pass but also to try to change for the better, however you define that. If Kosilek is putting on a show of remorse, it may be because the murder she committed is as distant in her memory as the things you did two decades ago are in yours. It’s a terrible truth about people who cause pain to others: They move on. The question is, should we?